Internal Medicine: A Doctor's Stories

Another valuable lesson learned: when reading blurbs, trust those from critics, not from writers. This was a bland book of essays about medicine and the human condition, written in a sort of philosophical poetic style. For people who like that sort of thing, this is the sort of thing they like.

One story has stuck with me: a patient who was admitted for tests, and it was cancer with no possible treatment. It was one of the first times the young doctor had to give news this bad, but he prepared and screwed up his courage and spoke to the patient, an older man. Patient was shaken but took it well. The next day the doctor came in to see him and patient was sunny and cheerful. "So doc, when are you letting me out of here?" "Mr. Soandso, remember our conversation yesterday? We're making arrangements for you to go into hospice." "Hospice! But that's for someone who's dying! What are you talking about?"
He explained again, and the guy acted as though he was hearing it for the first time. Again, shaken up.
Next day, same thing.
A social worker managed to get in touch with the guy's brother who confirmed that he had no short term memory, from years of drinking. ( )

The author tells us in a prologue that this is a work of fictitious non-fiction. His aim is to accurately represent the experience of a man becoming a doctor, without violating HIPAA, and without relying on specific cases or milieus that could lend themselves to lawsuits. As a work of fiction, it accomplishes its goal of educating the reader about hospital/medical hierarchies, & presenting the doctor's complex perspective on pain, suffering & death.

As someone already highly critical of modern medical institutions, this book did nothing to allay my fears that everything about the system is wrong, from the hazing that we call residencies, to the professional detachment (desensitization) that is worn like armor to shield doctors against the emotional burden of witnessing pain day after day after day.

Holt’s Internal Medicine drives home the fact that “best” medical practices today are bad for the patient, bad for the families of patients, and bad for the doctors. I can think of no other profession where the system itself demands you remain sleep-deprived, psychically unrested, exposed to near constant suffering & death, and physically separated from your friends, family and loved ones. Any sane employer would tell you this is a recipe for terrible employees: they would be prone to errors in judgment, demonstrate an impairment in fine motor skills, become embittered by their long hours & their inability to commune with those loved ones in whose arms they may find a smidgen of respite. In this hellscape the healers have no time to heal themselves. Do we value Health at any cost? ( )

Me han gustado todas estas historias de médicos, y en concreto la última me ha parecido una maravilla. ( )

Collection of short stories by a physician who was a published fiction author before going to medical school. The stories all focus on experiences of a doctor doing his hospital residency after completing med school. While the author's introduction makes it clear that the stories are fictional (albeit with some factual elements from his own experience and those of his colleagues), my local public library placed it in their BIOGRAPHY section.
The stories are interesting and well written. They combine medical diagnostic and treatment techniques with insight into the human condition. ( )

This is a stunning collection of beautifully crafted medical stories. While not exactly a memoir, the book is deeply informed by the author's experiences as a physician trained in internal medicine.

Holt, who has a PhD in English literature, a Master's of Fine Arts Degree, and is currently Assistant Professor of Social Medicine at Cornell, writes on his university profile page that he is "especially interested in how we confront our mortal condition, or fail to, and the roles narrative [the stories we tell ourselves or about ourselves]serves in that vexed recognition."

INTERNAL MEDICINE provides readers with a collection of characters, many of whom are in tenuous states due to cancer, heart failure, or even self-inflicted injury (as a result of mental illness). As readers, we are also invited to view patients through the eyes of Dr. Harper, seemingly Holt's alter ego, who struggles with exhaustion, awkwardness, his own fears about mortality, and even horror at some of the conditions he encounters.

Potential readers should be warned that there is little that is light about this book. In these stories, Holt illuminates dark places, not always making clear to us what is there, but certainly underscoring the mystery of living with/in a body.

This is one of the finest books I've read this year--one that begs a second reading and discussion with others.

For the brave who wish to meditate further on being human, pair this book with any of the following: Gawande's BEING MORTAL, Louise Aronson's A HISTORY OF THE PRESENT ILLNESS, and Henry Marsh's DO NO HARM. ( )